Second Best Governance? Governments and Governance in the Imperfect World of Health Care Delivery in China, India and Thailand in Comparative Perspective

Abstract

The objective of the paper is to assess the usefulness of conceptions of different modes of governance for understanding policy outcomes by studying the experience with hierarchical and non-hierarchical governance modes in the health care sector in China, India, and Thailand. The paper shows their experience with non-hierarchical modes to have been largely disappointing and that all three, but especially Thailand, are in the process of reverting to a more hierarchical mode of service delivery. The conclusion from this study is that non-hierarchical governance is not a substitute for or an improvement upon hierarchical governance in health care due to the many market and government failures that afflict the sector and affect the ability of different governance modes to function effectively. The hierarchical mode of government is also imperfect but less so than the alternatives in delivering health care.

Keywords:

• Markets
• States
• Networks
• Health

Additional information

Notes on contributors

M. Ramesh

M. Ramesh is Professor of Social Policy at the Lee Kuan Yew School of Public Policy, National University of Singapore. He specializes in public policy and governance in Asia with a particular focus on social policy.

Xun Wu

Xun Wu is Associate Professor at the Lee Kuan Yew School of Public Policy, National University of Singapore. He specializes in the analysis and evaluation of policy reforms in developing countries, with emphasis on social and environmental sectors.

Michael Howlett

Michael Howlett is Burnaby Mountain Chair in the Department of Political Science at Simon Fraser University and Yong Pung How Chair Professor in the Lee Kuan Yew School of Public Policy at the National University of Singapore. He specializes in public policy analysis, political economy, and resource and environmental policy.